![]() Many types of internal fixation devices have been introduced for intertrochanteric fracture. The pre-operative and the post-operative mean modified Harris hip scores were 63 and 72 respectively with an appreciable change in score of 9. Using the modified Harris hip score results were fair bearing in mind the mean age of the series being 80 years and oldest being 105 years. There were no other complications such as DVT, wound infection or non union. Limb shortening (1 to 2 cm) resulted from the collapse of the comminuted fragments in six cases. There was mild external rotation deformity of 10° in four cases. Patients in those cases complained of stiffness and pain above the knee due to painful bursa formation. Ender nails in five cases of advanced osteoporosis migrated distally though there weren’t any case of penetration into the knee joint as the entry point was from the adductor tubercle. There were no cases of the compression screw backing out or the nail cutting out proximally. The average time taken for fracture union was 10 weeks (range 6 to 16 weeks). The average surgery time was 35 minutes (range 25 to 45 minutes). The average blood loss during the surgery was 20 cc (range 15 to 40 cc). In the event of patient complaining knee pain, X-ray distal femur with knee AP was done. Successive reviews were done at six-week intervals during which rotations in flexion/extension, limb length discrepancy and knee range of motion were assessed. It was gradually progressed to full weight bearing as per tolerance and absence of radiological evidence of collapse. Partial weight bearing was initiated after the sixth week. During the first followup at one month xray pelvis with both hips anteroposterior (AP) view and involved hip lateral was done. Radiological assessment was done to verify the position of the implant as a check to compliance with the postoperative ambulation protocol. Patients were called for review after a month and assessed clinically for any limb length discrepancy and mal alignment of the limb. Non-weight bearing ambulation touch toe using a walker was permitted in self confident patients by the 10 th post-operative day. Quadricep strengthening exercises were encouraged from the first postoperative day. The distal migration of Enders nail was prevented by passing a K-wire through the eye of the nail in all cases using image intensifier. After drilling and tapping a single 6.5 mm cannulated compression screw was introduced across the fracture from the subtrochanteric region into the femoral head. The nails were then advanced across the fracture site into the proximal neck. This was followed by insertion of two Ender nails (4.5 mm diameter), 1cm proximal to the adductor tubercle into the canal. The appropriate nail size was ascertained by trial placements of nail over the limb using an image intensifier. A detailed informed consent was taken from each patient.įracture reduction was attained under image intensifier over a fracture table. ![]() The clinical and radiolographical assessment was done in all cases. ![]() All patients were treated within four days of the fracture. All patients were ambulant before sustaining fractures, except two hemiparetic patients who needed support to walk. The mean age of the patients was 80 years (range 70-105 years) 27 were males and 49 were females. The presence of co-morbidities like diabetes mellitus (n=33), hypertension (n=29), COPD (n=11), ischemic heart disease (n=8), CVA (n=2) and history of previous coronary artery bypass surgery (n=1) were also included. We included elderly patients of age more than 70 years having sustained a closed fracture without any pressure sores. There were 49 stable and 27 unstable intertrochanteric fractures (as per Evan’s classification). This prospective study includes 76 intertrochanteric fractures without subtrochanteric extension in high risk elderly cases presented between Jan 2004 and Dec 2007.
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